Silvia Roque

• Count money in cash drawers at the beginning of shifts to ensure that amounts are correct and that there is adequate change.
• Issue receipts, refunds, credits, or change due to customers.
• Receive payment by cash, check, credit cards, vouchers, or automatic debits.
• Greet customers entering establishments.
• Sell tickets and other items to customers.
• Maintain clean and orderly checkout areas and complete other general cleaning duties, such as mopping floors and emptying trash cans.
• Stock shelves, and mark prices on shelves and items.

• Take orders from customers and cook foods requiring short preparation times, according to customer requirements.
• Clean food preparation equipment, work areas, and counters or tables.
• Restock kitchen supplies, rotate food, and stamp the time and date on food in coolers.
• Perform food preparation tasks, such as making sandwiches, carving meats, making soups or salads, baking breads or desserts, and brewing coffee or tea.
• Accept payments, and make change or write charge slips as necessary.
• Perform general cleaning activities in kitchen and dining areas.

• Carry linens, towels, toilet items, and cleaning supplies, using wheeled carts.
• Clean rooms, hallways, lobbies, lounges, restrooms, corridors, elevators, stairways, locker rooms, and other work areas so that health standards are met.
• Disinfect equipment and supplies, using germicides or steam-operated sterilizers.
• Empty wastebaskets, empty and clean ashtrays, and transport other trash and waste to disposal areas.
• Sweep, scrub, wax, or polish floors, using brooms, mops, or powered scrubbing and waxing machines.

• Responsible for sustaining a sterile environment in all areas of the hospital by cleaning rooms, making beds, replenishing linens and maintaining floors.
• Collecting and disposal of waste, both contaminated and ordinary, and the removal and disposal of sharps containers.
• Operation of specified small equipment such as vacuum cleaners, upholstery shampooers, and other small equipment is required.  

• Process new enrollments, renewals, terminations, and eligibility changes.
• Verify completeness of member applications and supporting documentation.
• Input and update member records in internal systems and databases.
• Respond to member and client inquiries regarding enrollment status or corrections.
• Ensure compliance with federal, state, and internal enrollment standards (e.g. HIPAA, ACA
• Generate and distribute invoices and premium statements
• Post payments, track payments received or outstanding, and reconcile AR/billing reports.
• Address billing discrepancies, follow-up on delinquent accounts, set up payment plans, and escalate unresolved issues
• Respond to inquiries via phone or email about enrollments or billing
• Collaborate with clients, agents, and internal teams on status updates or issue resolution

• Updates Cactus with any add, changes or terminations of providers (Directly credentialed and Delegated providers)
• Updates Out of Network providers within our internal claim system

• Updates and manages provider payment preference within our internal claim system

• Triages and maps provider claim information within our internal claim system

• Pulls updates from Cactus to send weekly to the TPA's

• Creates / provides reporting on a weekly / monthly basis or as requested by team or management

• Sends fee schedules / rate changes to TPAs as needed

• Sends opt-ins and updates to the Medicaid CMOs on a weekly or monthly basis as required by the CMO’s

• Sends monthly reporting to various contracted entities (i.e., PHS-CI, payer rosters, etc.)

• Conducts system audits as part of our internal QA

• Maintains online provider directories

• Participates in data integrity projects as requested by team or management

• Stays involved in every aspect of data maintenance to the system

• Maintains regular and predictable attendance

• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice